Malaria

Question 1

Malaria is transmitted by what

Answer 1

The bite of a female an Anopheles mosquito

Question 2

What are the species that cause malaria

Answer 2

1. P falciparum
2. P vivax
3. P Ovale
4. P malaria
5. P Knowlesi

Question 3

which species caused the most dangerous infection

Answer 3

P falciparum

Question 4

What are merozoites

Answer 4

Sporozoites that multiply it inside hepatocytes

Question 5

What happens in the pre- erythrocytic phase

Answer 5

Protozoa enters via mosquito bite and travels to the liver where infects the parasites and multiplies there. The infected hepatocytes rupture and then released into the bloodstream

Question 6

Which species remain dormant in the liver as hypnozoites which remain dormant and reactivate causing relapsing infection 

Answer 6

P. Vivax and P. Ovale

Question 7

What is the erythrocytic stage

Answer 7

Inside the red blood cells parasites Attach through the Duffy antigen and then multiply again 

Question 8

In which disease is the Duffy antigen absent

Answer 8

Sickle cell anemia 

Question 9

Which diseases wore off malarial infection

Answer 9

1. Sickle cell anaemia
2. thalassaemia
3. G6PD deficiency

Question 10

Which species invades reticulocytes

Answer 10

P. Vivax

Question 11

How does P falciparum avoid destruction in the spleen

Answer 11

It generates a sticky routine that coat’s the surface of infected RBCs. Looks like knobs. They block blood vessels and avoid destruction in the spleen

Question 12

 What is Blackwater fever

Answer 12

The passage of dark urine haemoglobinuria in P. falciparum malaria infection. It is due to widespread intravascular haemolysis

Question 13

What are the complications of severe falciparum malaria

Answer 13

1. Cerebral malaria
2. Blackwater fever
3. DIC
4. severe anaemia
5. acute respiratory distress syndrome
6. hypoglycaemia
7. metabolic acidosis
8. G.I. problems (diarrhea, jaundice, splenic rupture)
9. Shock-hypotension
10. hyperpyrexia
11. Oliguria
12. acute renal failure

Question 14

What are the clinical features of P malaria

Answer 14

1. Qurtan fever - fever reoccurs after every 72 hours
2. Associate with glomerulonephritis and nephrotic syndrome

Question 15

What are the clinical features of P. Vivax and p. Ovale 

Answer 15

1. Benign tertian malaria fever spikes every 48 hours
2. anaemia with tender hepatosplenomegaly
3. hypnozoites in liver can cause relapse infection

Question 16

How do you diagnose malaria

Answer 16

1. Giemsa stain stained thick and thin blood films
2. Rapid stick tests that detect malarial antigens

Question 17

What does thick blood smear show

Answer 17

Confirmation of malaria Infection

Question 18

What does thin blood smear show

Answer 18

Identifies the species of the parasite

Question 19

What are the symptoms of acute malarial infection

Answer 19

1. Anorexia, headaches, and fevers
2. Paroxysmal fever

Question 20

What are the stages of paroxysmal fever

Answer 20

1. Cold stage. patient feels very cold for about 30 minutes to an hour. Temperature rapidly rises
2. Hot stage. Shivering stops patient feels intense heat
3. Sweating stage. Patient breaks into profuse perspiration temperature declines. Patient feels relief

Question 21

What are the clinical forms of falciparum malaria

Answer 21

1. Cerebral malaria
2. Algid malaria
3. septicaemic malaria
4. Blackwater fever

Question 22

What is an important clinical finding of Algid malaria

Answer 22

Peripheral circulatory collapse

Question 23

What is an important finding of septicaemic malaria

Answer 23

Hepatorenal syndrome and spontaneous splenic rupture

Question 24

How do you treat falciparum malaria

Answer 24

1. Quinine10 mg /KG 12 hourly IV
2. blood transfusion
3. Mannitol if oliguria develops

Question 25

What is the treatment of acute attack malaria sensitive to chloroquine

Answer 25

Chloroquine 250 mg given as follows 1. 4 tabs stat 2. 2 tab after six hours 3. 1 tab twice daily for the next two days After successful treatment it is necessary to give 2 to 3 weeks course of primaquine 15 mg /day 

Question 26

What drug is used to eradicate Hepatic hypnozoites and prevent relapse

Answer 26

Primaquine 15 mg per day

Question 27

Which drug maybe used if chloroquine is not tolerated

Answer 27

Amodiaquine

Question 28

What other drugs can be used if chloroquine resistant malaria occurs

Answer 28

1. Artemether 2. Quinine sulphate 3. mefloquine - 20 mg/KG in 2 doses eight hours apart 4. Fansidar - Three tabs stat 5. Halfantrine - two tabs six hourly (Total six tabs)

Question 29

What is the course of artemether

Answer 29

1. Artem To stat injection in gluteal area and one daily for four days 2. Artemether 80mg , lumefantrine 480mg. 3 days twice daily 

Question 30

Why is Lumefantrine used in combination with arthemether

Answer 30

It has a much longer half life and clears any residual parasites

Question 31

Explain the course of quinine sulphate for malarial infection

Answer 31

600 mg TDS For five days followed by a single dose of three tab fansider (sulfadoxine 1.5 mg + pyrimethamine 75mg) 

Question 32

What is tropical spleenomagaly syndrome

Answer 32

It is a syndrome with exaggerated immune responses to repeated malaria infections. It occurs in areas where malaria is hyper endemic.

Question 33

What are the characteristics of tropical splenomegaly syndrome

Answer 33

1. Anaemia massive 2. splenomegaly 3. marked elevation in serum IgM antibodies 4. Malaria parasites are usually absent in peripheral film

Question 34

What is the management of tropical splenomegaly syndrome

Answer 34

Proguanil 100 mg daily for years with folic acid 5 mg daily